Could gaps get capped in funding shakeup?

When it comes to Medicare reform, the Health Minister says nothing is off the table. Except increasing patient rebates.

---

Weeks out from the much-anticipated Strengthening Medicare Taskforce report, Health Minister Mark Butler is keeping his cards very close to his chest.

So far, all that’s clear is that the imminent shakeup will not involve increased patient rebates, but may include block funding and will promote better use of nurses and allied health practitioners.

“I’ve … been clear that more of the same is not going to cut it,” Mr Butler said.

“And I think a range of commentators have also reflected on the fact that simply adding more money to the existing structures is not going to deliver the quality, wraparound care, particularly people with complex chronic disease need and deserve.”

When asked repeatedly by a journalist whether he could or would consider capping what doctors could charge for gap fees (which would likely require extensive legal changes if it is even possible) Mr Butler did not acknowledge the question directly. An alternative possibility was “flexible” funding including block payments for chronic care – essentially voluntary patient enrolment.

“Obviously, [another] way in which to do this is to provide a larger lump sum which has flexible arrangements to treat particularly someone with very complex chronic disease, you see that in many countries around the world,” he said.

“We’re not replacing and there’s no one advocating for replacement of fee-for-service.”

The question, Mr Butler said, is not whether fee-for-service should stay, but rather how the government can provide flexible block funding that could see more clinicians involved in team-based care.

Reactions from major GP representative bodies have been cool so far, with the RACGP calling for further detail to be released.

Australian Society of General Practice president Dr Chris Irwin called for the AMA and RACGP to “disengage” from the taskforce entirely.

“The RACGP and AMA need to realise that the ‘brave new world’ of Medicare envisaged by Labor is not for the benefit of the patient,” he told The Medical Republic.

“It is a cost saving measure, in which the government is also able to cosy up to its political fundraisers and unionists.”

Practice owners association Australian GP Alliance deputy chair Dr Mukesh Haikerwal was cautious about what the shakeup could mean.

“I think that we’re being be set up as puppets and we will be set up to fail,” he told TMR.

“Unfortunately, I think the [reporting in Nine Newspapers and the ABC late last year] killed any chance of a budgetary injection.”

The devil in the multidisciplinary team care detail will be whether GPs stay at the centre of patient care in a team environment or whether care ends up fragmented among different disciplines.

Dr Haikerwal, for instance, had a positive experience with block funding while running a respiratory clinic during the pandemic.

“It gave the freedom for us, as providers, to deploy people from any discipline that we liked to enhance the service that we gave,” he said.

“We employed, in particular, paramedics, paramedics in training, nurses, nurses in training and other health science students in training.

“They provided very good support to the health professionals to do the work, so the workers could work more efficiently.”

The prospect of care being split across professions – à la the upcoming Queensland pharmacy prescribing trial – was a hard no for Dr Haikerwal.

“If you want to be a clever dicky-doc, get a clever dicky-doc degree,” he said.